Health care consumerism and price transparency tools: Are your employees equipped?
It’s time we ask ourselves if the employee benefits industry is giving members the resources they need to educate themselves to make savvy decisions,
Recently, several states and the Centers for Medicare and Medicaid (the largest health care payer) have implemented health care price transparency measures to help address the unsustainable rise of health care costs. Experts anticipate that pricing information and comparison shopping will allow competition to push prices lower. While price transparency tools are a big improvement, we also need to ensure that consumers are equipped to use that information to make smart decisions.
Related: Poll: Few Americans aware of new price transparency rules for hospitals
As an employee benefits consultant, part of my job is to help employers provide the best health care coverage that is financially responsible for both the plan and the member. Many modern plan designs are meant to incentivize members to be savvy buyers—meaning they find the top providers for the service they require and compare prices—a practice we call health care consumerism. However, opaque pricing and the pressure of making the “right” decision as it pertains to our families’ health—often in stressful situations—makes shopping for providers difficult.
Price transparency is undoubtedly essential to changing behavior and lowering costs, but if the consumer doesn’t understand the implications and interactions of deductibles, networks, copays, coinsurance, etc., then that extra data just adds to the confusion. One study found that increased access to pricing information through a health care cost comparison site didn’t lead to increased use of lower-price providers. Consumers struggled to incorporate this information in their decisions. And this is about more than just finances. Lower benefits literacy can lead participants to delay or avoid medical care.
Supplying the resources
It’s time we ask ourselves if the employee benefits industry is giving members the resources they need to educate themselves to make that savvy decision. In some cases, you might find that you ask for participation but don’t supply the tools.
Here are some ways to reinforce a culture of health care consumerism:
Literature and how-to guides
Sometimes the hardest part of getting help is asking for it. Many of us hate to admit when there’s a gap in our understanding, especially if the topic is something many consider common knowledge.
Health insurance is a great example: We all know how important it is, but with so many complex interlocking pieces, it can be hard to fully understand. In fact, in a recent survey, more than 56% of respondents admitted that they feel completely lost when it comes to navigating their insurance benefits.
How can we expect our participants to be savvy shoppers when they don’t understand their shopping list? Your benefits broker can offer smart guides, glossaries and other educational materials designed to fill this gap. Consider a “health insurance 101” lunch-and-learn session or video series where common insurance terminology is defined, questions are answered and tips for getting the best price are shared.
These types of guides and resources are a relatively low-cost solution that can get us ever closer to the goal of total health care literacy.
Taking advantage of tech
Once your team is speaking the same benefits language, you can be more confident they will get the most of any tool you hand them. Many insurance carriers offer apps and services with price transparency tools. These tools help users compare prices for common procedures and services. They also provide reviews of the providers that can potentially call attention to common billing and administrative issues. Other apps dedicated to finding the best prescription drug price are widely available and can provide considerable savings.
Advocacy
Benefits advocacy can come in two forms: outside assistance from a benefits concierge, or self-advocacy in the form of questions and expectations. For instance, if a participant can spot red flags, they can self-advocate or ask for additional assistance from a trusted source.
One of the most common participant complaints, especially when it comes to medical billing, occurs during an elective procedure: a surprise bill appears when an approved service is performed, but a member of the care team is out of network. This can be remedied if members know their rights and have a list of questions to ask before the procedure takes place.
In many cases, members and employees hold the key to many of the cost-reduction opportunities we face daily. But, in order to achieve those savings, we need to arm our people with the knowledge and confidence to make informed, savvy decisions. Price transparency tools are essential, but they’re just one piece. Technology has made once obscure information more accessible. Ensure your employees are taking full advantage of all the available tools by making them benefits literate.
John Crable is senior vice president of Corporate Synergies.
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